Time, stress take toll on presidents’ appearance

WASHINGTON – Time roughs up presidents. Photos of Barack Obama on election night in 2008 look like they were taken much longer than four years ago. Now his face has deeper creases and crow’s feet, while his hair is salted with white.

“You look at the picture when they’re inaugurated, and four years later, they’re visibly older,” said Connie Mariano, a former White House physician whose stethoscope checked presidential hearts from 1992 to 2001. “It’s like they went in a time machine and fast-forwarded eight years in the span of four years.”

That’s because of the unabated, unfathomable stress that presidents face. “You see it over a term,” said Ronan Factora, a physician specializing in geriatric medicine at the Cleveland Clinic. “It’s a good study of chronic stress on a person’s overall health.”

Changes in skin or hair are gradual, he said. “If you do have a stressful event, nothing is going to happen right away.” Nothing visible, anyway.

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Inside the body, the pituitary gland jolts the adrenal gland, just above the kidneys. Hormones start coursing. Adrenaline cranks up the heart rate and blood pressure. Cortisol, another hormone from the same gland, causes inflammation and preps the body for converting sugars into energy.

“It’s not intended that people would be chronically exposed to these levels,” said Sherita Golden, a physician at the Johns Hopkins Bloomberg School of Public Health.

Cortisol strains the circulatory system, battering artery walls. The hormone also thins the skin and makes muscles and bones lose mass. The immune system weakens, and viruses that cause colds and cold sores take hold. Sleep turns fitful.

“Your cognition slows, you may feel more depressed, your ability to concentrate goes down,” Factora said. “And it just builds on itself — a real cascade.”

There is one known treatment for stress: exercise. “It is the best benefit a physician can recommend,” Factora said. “There is no drug that can present as many benefits as exercise can.”

Obama is a fiend for exercise. In hourlong workouts, he has been known to hit treadmills hard, weight train with arms and legs and build quickness through “plyos,” or plyometrics, exercises that involve explosive movements. He also throws footballs, shoots basketballs and thwacks at golf balls.

His predecessors exercised, too, some of them fiercely. George W. Bush ran till his aging knees made cycling a better option. Presidents Carter and Clinton jogged, while Ronald Reagan rode horses and split logs with such vigor, he once cut his thigh. President Ford performed a daily exercise regimen in his robe and PJs.

President George H.W. Bush “didn’t just work out, he worked out vigorously,” said his physician, Burton Lee, citing 4-mile runs and ball games with Marines at Camp David, Md. Once he played tennis with Pete Sampras.

“He broke the StairMaster at Camp David; he pounded it till it didn’t work,” Lee recalled. “If I’m on it for five minutes, you have to take me out on a stretcher.”

Good exercise leads to better thinking, brain mapping has shown. “Exercise actually brings more blood flow,” said Linda Fried, an epidemiologist and geriatrician at Columbia University. “Parts of the brain are activated, and they’re associated with complex thinking and problem-solving.”

Workouts also force a president to — truly, finally, deeply — rest. Only then can the relaxed brain start to make creative associations.

Obama had a fitness test Jan. 12, and the White House said the results would be released by February.

Like all presidents since 1992, he is under constant medical watch: A military physician is on hand wherever a president goes, day or night. That firsthand observation started with former White House physician Mariano, and even with all her access, she recalled how difficult it was to determine on many occasions whether Clinton was just super-stressed or full-on infirm.

“We were worried about Clinton when he was being impeached,” she recalled. “He looked like he had it all together, but we worried.” When she and her colleagues asked, all he would say was, “I’m tired.”

Lee, whom the first President Bush brought to the White House to monitor his health, agreed with Mariano that presidents are a special lot. They push their bodies and minds, and thus develop a greater capacity to fight off infection. They shake enough hands to fell a lesser creature, he said.

But the mental intrusions — the sense that someone needs something every moment of every day — are as insidious as the germs. “It’s just a phenomenally demanding job,” Lee said. “You never get one minute off.”

The job has compounded certain human frailties. Most famous perhaps is the lethal case of pneumonia that William Henry Harrison, 68, caught at his inauguration.

But daily habits also affect presidential well-being in lesser-known ways. Dwight Eisenhower was so dedicated to his form of exercise that he played 800 rounds of 18 holes over eight years as president, according to Evan Thomas, author of “Ike’s Bluff: President Eisenhower’s Secret Battle to Save the World.”

Then, in 1955, Eisenhower had a heart attack, and two years later, a stroke. Intestinal surgery came in between, all as he was staving off nuclear war and realigning Southeast Asia.

“Toward the end,” Thomas said, “he was taking an extra sleeping pill at night” — the powerful, old-school kind, with barbiturates. And that was on top of a nightly scotch, never more than 5 ounces, except when it was, Thomas said. “A couple of times he says to his doctor, ‘Let’s get drunk.’ ’’

To the best of the public’s knowledge, recent presidents have not exacerbated their stress through bad behaviors such as drinking. Obama, however, admitted to kicking a cigarette habit of unknown intensity at some midpoint in his first term.

The side effects of smoking might show up as those lines in his face, the doctors said. While sun exposure can also make a face look withered, Obama’s darker skin has melanin to alleviate UV-ray damage. That same coloring, however, can make his white hair look more pronounced.

Like appearance, endurance is individual: One person crumbles in circumstances in which another thrives; what one person actively avoids, another embraces. “The one thing I noticed is that presidents have very unusual personalities,” Lee said. “Each is a different person, but for all, there is no easy day.”

Despite the extraordinary stress, many recent presidents have lived well beyond normal life expectancy. Reagan and Ford died at 93; Carter and George H.W. Bush are 88.

Doctors are coming to understand that stress may have an upside. “Human beings need some degree of stress to keep their systems tuned,” Fried said. “Some people enjoy the stimulation of it and the excitement and couldn’t live without it.”

Plus, human minds literally seek reasons to live. “Many people, as they get older, deeply care about future generations and the world’s survival,” Fried said. “If they have a chance to make a difference, that keeps people healthy.”